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Born With One Kidney vs. Acquiring (Reducing) One

Far too many times, I’ve heard laypeople defend the ‘safety’ living kidney donation by invoking the fact that some people are born with one kidney and ‘do just fine’. It’s annoying mostly because it’s a flawed argument. Folks born with one kidney wouldn’t know they only had one until/unless something went awry, or they were undergoing testing for some other sort of health-related issue.

So do we know the true number of folks born with one kidney? Not really.

And do we know those one-kidneyed folks function equally to those born with two? Not particularly. A person can function with one eye but we wouldn’t say it was equal in all ways to those with two.

 

Some Romanian authors help make my point for me:

The congenital SK [single kidney] possesses a higher number of nephrons (75%, as compared to 2 functional kidneys in a healthy person) than the surgically acquired SK – 50% nephrons.

This makes adaptive phenomena differ.

 

The researchers then list the reasons a person with a single kidney is of interest to nephrologists, including:

the causal relationship between the number of nephrons and the development of arterial hypertension (AH) is discussed in the literature, the SK kidney being a study model

 

Research has demonstrated an increase in blood pressure in living kidney donors, as well as a link between kidney disease and hypertension.

 

The consequences of the [single kidney] SK are well defined:
– proteinuria, observed in persons with both congenital and acquired SK
– AH, observed in persons with both congenital and acquired SK
– reduced glomerular filtration rate (GFR)

 

Watch that blood pressure, and see your doctor regularly…

 

GH. GLUHOVSCHI, FLORICA GADALEAN, CRISTINA GLUHOVSCHI,, & LIGIA PETRICA, SILVIA VELCIOV, A. GLUHOVSCHI, R. TIMAR 2,3 (2013). The solitary kidney – a nephrological perspective ROM. J. INTERN. MED, 51 (2), 80-88

7 replies on “Born With One Kidney vs. Acquiring (Reducing) One”

The most recent medical studies that I have seen report that 1 in 750 people are born with one kidney. My guess is that it is more than that as so many don’t find out until they are going through some sort of testing.

Since I am not in the medical community I can’t give advice on this. I can only say that I personally felt very comfortable going through the rigid testing process required for someone to donate. I agree that there is always a risk, but I also believe that there is a risk with everything. I consulted multiple physicans on my own aside from the testing. My history, family history was important as well.

Your point is well taken, but I could be hit by a bus tomorrow too. I think it’s a personal decision that each person needs to seriously weigh, look at the phase that they are in with their life and be willing to take that chance.

Unfortunately, the testing process hasn’t historically been ‘rigid’. In fact, there were no national standards for living donor evaluation until 2013, and that policy is still being implemented (and it is far from perfect). This means that for the last 50+ years, every transplant center has been able to make up their own rules and determine what is or isn’t an acceptable living donor. Even in the most current OPTN documents, it states that prospective living donors should be told that if they are refused at one center, another center may accept them. That is anything but ‘rigid’.

People considering living donation deserve to have the tools necessary to make the best decision possible for their particular situation. However, the messages the transplant industry and media perpetuate about living donation are often erroneous, and by and large, incomplete. Your website, for example, says that donating a kidney is ‘saving a life’ when in fact, a transplant isn’t a guarantee, isn’t a cure, and isn’t the only treatment available for end-state renal disease. To characterize living kidney donation as ‘life saving’ is both factually incorrect and manipulative. And while your website claims it wants to ‘provide up-to-date information’ for prospective living donors, your resource page is incredibly limited and one-sided.

Anyone connected with kidney recipient Harvey Mysel and his organization, whose sole purpose is to increase living donor kidneys for recipients, then claims to want to ‘protect donor rights’ is being more than a little disingenuous. To use your analogy, it’s sort of like telling people “Sure, there are risks to walking out in front of that bus, but think of what a rush it’ll be if you don’t end up dead”.

Well we agree to disagree. Although you may have the assumption that lkdn.org and lkda.org give a misleading perspective is ricidulous. Harvey Mysel most likely knows more about the kidney transplant procedure as well as risks than most people who are in the transplant community. It is not a bed of roses but it’s not the ugly picture that you are painting as well. As a living donor, I feel that all living donors should be entitled to annual checks ups at no cost for life as well as not being turned down for medical insurance. These are things that the living donor community are lobbying for. The testing is rigid. There are transplant centers throughout the US that are better experienced in the the living donor process than others. UNOS (United Network of Organ Sharing) has been a very important group that mandates protocal for living donors. My testing was extremely rigid. If there are centers that are not adhering to the UNOS policy then they should be reported to the UNOS committee. The reality is that each individual owes it to themselves to make the most informed decision they can, this include the positive as well as the negative. But for you to make a statement that organizations are making it their sole purpose to increase living donors is a bullet well wasted. My goal personally is to share the realistic side of donating, what to expect in the healing process and things that will make the donor experience a better one. In no way do I ever allow my enthusiasm sway or influence someone to donate. I am here however to answer questions about the living donor experience honestly and sincerely.
A living tranplant is not a “cure” however it is allowing a human being to live a longer and better life. When patients are on dialyisis for long periods of time their bodies have become so sensitized that they most likely will never be a candidate for a transplant.
Of course we want to protect donors rights. Donating a kidney is not a piece of cake and the last thing any donor wants is to feel that now that their organ has gone to help somone else that they are forgotten or are just a piece of meat. You have only concentrated on the negative aspects and not presented any of the positive which is extremely biased. Each person has to make this decision for themselves. I can only hope that you never need a kidney.

I find it interesting that you offer no proof or source documents for your assertions. LD101 and LDPT does nothing but link to resources, studies, etc. At no point would I expect anyone to take my word on anything.

Transplants are not always successful, and not everyone who has a transplant has a ‘long and better’ life. See SRTR.org’s stats for graft and/or patient survival and you’ll know it’s true.

In addition, not everyone is a good candidate for transplant (co-morbidities, age, diagnosis, etc), so portraying dialysis as a death sentence is not helpful. Many people fare quite well on dialysis, and for some, it is a better treatment option than transplant. For one doctor’s story of his own end-stage renal disease: http://www.livingdonor101.com/some-living-donor-love-from-a-doctor-with-kidney-disease/

UNOS is nothing but a contractor. They have no authority, power or influence in and of themselves. OPTN is the federally created membership organization that develops transplant policy (Please learn the difference). OPTN was created by NOTA in 1984 to administer a national system for DECEASED donation. The thought was that by maximizing deceased donation and allocation, the need for living donors would be minimal, at best. This has not happened because the transplant industry has, instead, focused on increased living donation. All one has to do is look at a sample of transplant center websites to see how they misrepresent the reality of what it means to be a living donor. See here: http://www.livingdonor101.com/if-every-transplant-center-says-it-it-must-be-true/

OPTN has absolutely NOT helped protect living donors. In 2000, the Secretary of Health mandated transplant centers report one year of follow-up on all living donors. OPTN has NEVER enforced that policy, and a decade later, almost 40% of kidney donors were still reported ‘lost’ by one year – with no proof contact had even been attempted. See here: http://www.livingdonor101.com/the-latest-on-living-donor-follow-up-hint-its-still-really-really-bad/ (You can already read OPTN’s own LD task force report which called the OPTN database ‘woefully inadequate’ and ‘useless’ for research and analysis).

OPTN’s living donor committee tried to implement national standards of living donor treatment back in 2007, but the transplant industry so violently reacted that the documents were watered down and turned into ‘voluntary guidelines’ (See here: http://www.livingdonor101.com/from-proposed-policy-to-wimpy-guidelines/ and here: http://www.livingdonor101.com/follow-up-on-unos-lame-2007-recommendations/ and here: http://www.livingdonor101.com/more-on-that-2007-unos-living-donor-policy-debacle/). The only reason they reintroduced standards last year is because HRSA ordered them to do so (The proposed policy documents on OPTN’s website clearly state this; feel free to read them). As I mentioned above, the standards include so much variability that prospective LDs are told to simply go to another facility if they’ve been rejected.

If I do need a kidney, it is because I believed the transplant industry when they told me living donation was safe, and that I didn’t need to change anything about my lifestyle after donation. And if that happens, and my remaining kidney fails, I can guarantee you this: I won’t accept a living donor kidney.

Also…when you look at the participants on kidney disease/dialysis group, you’ll find a number of people born with one kidney who are now classified as having kidney disease, kidney failure or are now on dialysis.
True, many of them didn’t realize they have kidney disease or only one kidney until later in life (and a few while volunteering to be a donor) but the same is applicable to people of two kidneys. Just because someone with kidney disease has no blaring symptoms (and a few don’t, even down to stage 5,if these patients are to be believed and not minimizing their own symptoms) doesn’t mean they do not have kidney disease.

The horse has been beaten on this. There is no true proof that living with one kidney is any different than two.
There are heredity factors that should be considered when donating a kidney and again, I stress that this is a decision that each individual must evaluate and decide on their own. None of us have any guarantee that an illness will not strike us. I feel that what you want to say is not to take any information lightly which I agree with but you still will not convince me that donating does not “save a life”. I propsose you ask all of those who were fortunate to receive a new kidney if they feel that way.

It’s ridiculous to say there’s “no proof” that living with one kidney is any different than living with two. If the human body didn’t have need for two kidneys, it wouldn’t have them. At no time would anyone say that “living with” one ear, eye or limb is no different than living with two. To say otherwise is just being obstinate.

For but one example, pregnancy with one kidney has shown to increase maternal and fetal risks:
http://www.livingdonor101.com/risks.shtml#PREGNANCY_POST-TRANSPLANT

You might want to consult these authors on the difference between being born with one kidney and acquiring one (aka losing a kidney) later in life:

http://www.livingdonor101.com/born-with-one-kidney-vs-acquiring-reducing-one/

The difference between us Cara, is that I advocate for anyone considering living donation or anyone who has already become a living donor. As indicated by the comment you just made, as well as your earlier insult of “I can only hope that you never need a kidney”, makes it very clear that your allegiance lies with those afflicted with end-stage renal disease and not those who sacrifice for them. It’s impossible to claim to be neutral while spewing misinformation (eg. the testing process is rigid), and it’s even more impossible to protect donors while simultaneously promoting living donation.

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